Provider Demographics
NPI:1457122632
Name:GONZALEZ, ENRIQUE I (CADC)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:
Last Name:GONZALEZ
Suffix:I
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 FRELINGHUYSEN AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07114-1404
Mailing Address - Country:US
Mailing Address - Phone:973-596-2850
Mailing Address - Fax:973-596-8180
Practice Address - Street 1:461 FRELINGHUYSEN AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07114-1404
Practice Address - Country:US
Practice Address - Phone:973-596-2850
Practice Address - Fax:973-596-8180
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37CA00130600101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)